1. Balancing Act: Launching Pentacel during the Hib Shortage Jan Hicks-Thomson, MSW, MPA Washington State Department of Health

2. Problems Identified Concern Disease Concern Missed Doses Extra Visits Wait Lists Limiting Shots Extra Work Worried Parents

3. Response No New Doses No ACIP Change “Enough” Listen Respond Transfer Reallocate Guidance from VAC

4. Was the Allocation Enough? 87,000 (projected births 08) x3 (shortage series) 261,000 (sub-total) % 12 (monthly average) 21.750 (@ 100%) x.90 (expected rate) 19,574 (calculated need) Order HistoryBirth Cohort

6. Spreading the News at Light Speed Communication

7. Support Tools

8. Population Based 2 Product Allocation CountyJanuary TotalActHibPentacel Adams1200 Asotin2100 Benton - Franklin920290 Chelan - Douglas380120 Clallam19090 Clark4401460 Benton-Franklin Hib Order TrackingJanuary ActHibPentacel Total Monthly Allocation920290 Balance (MUST BE ≥ 0)730230 PINProvider NameApproved 152001Delos, Reyes C.5020 152002Richland Family Medicine40 152004Chou, H.D.5020 152006Ahart, S.20 152007 Columbia Family Medicine3020 Allocation Strategy

9. Overlay High Volume Providers PINName Monthly Hib Pediarix Inventory 181045MALLARD PEDIATRICS196195 181037MARINER PEDIATRICS- PINELAKE139not entered 181135GRIFFEY PEDIATRICS143150 195002SOUNDER MEDICAL250595 197003YELLING PEDIATRICS200320 193005OLYMPIC PRACTICE200191 187107GENOME KIDS CLINIC200235 186054SEAHAWKS CLINIC - Lake Stevens100not entered 186056SEAHAWKS CLINIC - Silver Lake100not entered 191005BUNKO PEDIATRICS250484

10. Clallam Jefferson Grays Harbor Pacific Whatcom 1 Skagit 3 Snohomish 6 King 23 Pierce Lewis Mason Cowlitz Thurston 2 Clark 5 Skamania Klickitat Yakima 2 Kittitas Chelan Douglas Grant Okanogan Ferry Stevens Pend Oreille Spokane 2 Lincoln Adams Whitman Franklin Benton Walla Walla 1 Columbia Garfield Asotin Kitsap 9 Counties 45 Provider Sites Beginning Provider Participation

11. Hib Containing Vaccine Before and After Pentacel May 2008 – Feb. 2009 45 413 322 66 158

12. Clallam 5 Jefferson 1 Grays Harbor 2 Pacific Whatcom 10 Skagit 6 Snohomish 32 King 171 Pierce 49 Lewis 1 Mason 1 Cowlitz 2 Thurston 15 Clark 26 Skamania 1 Klickitat Yakima 19 Kittitas Chelan / Douglas 6 Grant 4 Okanogan 2 Ferry Stevens Pend Oreille Spokane 16 Lincoln Adams1 Whitman 2 Benton / Franklin 24 Walla Walla 5 Columbia Garfield Asotin Kitsap 10 Island 1 N.E. Tri 1 27 Counties 413 Provider Sites Wahkiakum Ending Provider Participation

13. Trouble Shooting Single Dose Disease Risk New Vaccine Medical Errors Inventory Management Lot Numbers

14. Vaccine Supply Issues Pentacel, Hep. B and Pediarix July 2008 – Feb 2009

15. Inventory Management Pediarix Inventory: February # Providers Inventory (doses) 2>500 3301 - 500 19101 - 300 32100 359<100 Hepatitis B Back-Orders Week# Providers 3/16/0920 3/20/0960 Through MayNormal Supply? Summer 2009Spotty Supply? Fall 2009Normal Supply?

16. How Are We Doing? Year All Cases Type B Up to Date Ages B Type Cases 2006511 3 mos. 2007631 0, 3, 14 mos. 200820N/AN/A 20092UKUKUK HiB Disease Reported in Washington

17. How Are We Doing? Born 11/1/07 to 3/31/08 Receiving 1, 2, and 3 doses by 9 months of age DoseHibPCV-7 196.2%96.7% 1 & 282.4%85.1% 1, 2 & 355%64% Children w/ 2 or more immunizations. Getting Kids Vaccinated in Washington Registry Recorded Doses Area3 Hib3 IPV4 Hib Adams89%90%4% Grant88%89%8% Chelan90%89%11% Douglas92% 14% Based on Immunization Registry Data

18. National Immunization Survey Results Washington State NIS Rates and Rankings, 2007-2008 Vaccine 20072008Difference, 2007-2008 RateRankRateRankRateRank 4+DTaP80.9±5.44182.7±5.0331.8±7.3 ↑ 8 3+Polio85.1±5.14988.7±4.1483.6±6.6 ↑ 1 1+MMR90.5±3.93691.2±3.5330.7±5.2 ↑ 3 3+Hib90.1±4.04189.6±3.924-0.6±5.6↑ 17 3+HepB85.0±4.74988.8±3.9483.7±6.1 ↑ 1 1+Var84.0±4.94486.8±4.1432.8±6.4 ↑ 1 4+PCV73.8±6.03077.2±5.5363.5±8.2 ↓ 6 4:3:1:3:3:169.0±6.14673.5±5.8324.5±8.5 ↑ 14 4:3:1:3:3:1:464.6±6.23067.3±6.2252.7±8.8 ↑ 5

19. Held our own with rates! How Are We Doing? Implementation – System Indicators Successful Integration Within Reason of ACIP Balance with CDC Reports Responsive to Providers Never over Allocation Secured Additional Vaccine

20. Acknowledgements Mike Bin Wendy Bowman Chris Halsell Flo Zikas Janna Bardi Lin Watson Contact: Jan Hicks-Thomson, MSW, MPA Jan.Hicks-Thomson@doh.wa.gov 360-236-3578 Blessed are the Balanced, for they shall outlast us all!